INTERNATIONALHEALTH

REGULATIONS

By

DR.VENU BOLISETTI

M.B.B.S,D.P.H,

pg in M.D (community medicine)

AIM a) assist countries to work together to save

lives and livelihoods endangered by the spread

of diseases and other health risks, and

b) avoid unnecessary interference with

international trade and travel.

The international health regulations evolution

The International Health Regulations originated with the International Sanitary Regulations adapted at the International Sanitary Conference in Paris in 1851.

The cholera epidemics that hit Europe in 1830 and 1847 made apparent the need for international cooperation in public health.

In 1948, the World Health Organization Constitution came about.

The Twenty-Second World Health Assembly (1969) adopted, revised and consolidated the International Sanitary Regulations, which were renamed the International Health Regulations (1969).

The Twenty-Sixth World Health Assembly in 1973 amended the IHR (1969) in relation to provisions on cholera.

In view of the global eradication of smallpox, the Thirty-fourth World Health Assembly amended the IHR (1969) to exclude smallpox in the list of notifiable diseases.

During the Forty-Eighth World Health Assembly in 1995, WHO and Member States agreed on the need to revise the IHR (1969) most notably:

narrow scope of notifiable diseases (cholera, plague, yellow fever),

The past few decades have seen the emergence and re-emergence of infectious diseases.

The emergence of “new” infectious agents Ebola, Hemorrhagic Fever and the re-emergence of cholera and plague in South America and India, respectively;

dependence on official country notification; and

lack of a formal internationally coordinated mechanism to prevent the international spread of disease.

These challenges were placed against the backdrop of the increased travel and trade characteristic of the 20th century.

The IHR (2005) entered into force, generally, on 15 June 2007, and are currently binding on 194 countries (States Parties) across the globe, including all 193 Member States of WHO.

In 2010 at The Meeting of the States Parties to the Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and Their Destruction in Geneva the sanitary epidemiological reconnaissance was suggested as well-tested means for enhancing the monitoring of infections and parasitic agents, for practical implementation of the IHR (2005) with the aim was to prevent and minimize the consequences of natural outbreaks of dangerous infectious diseases as well as the treat of alleged use of biological weapons against BTWC States Parties.

The significance of the sanitary epidemiological reconnaissance is pointed out in assessing the

1. sanitary-epidemiological situation,

2. organizing and conducting preventive activities,

3. indicating and identifying pathogenic biological agents in the environmental sites,

4. conducting laboratory analysis of biological materials,

5. suppressing hotbeds of infectious diseases,

6. providing advisory and practical assistance to local health authorities.

Achieving international public health security is one of the main challenges arising from the new and complex landscape of public health.

Strengthening countries' disease surveillance and response systems is central to improving public health security in each country and globally.

WHO's unique public health mandate, worldwide network, well established global partnership and long-standing experience in international disease control constitute an exceptional and unique asset for supporting countries in strengthening their capacity and for achieving international health security.

The IHR comprise a legal instrument specifically designed to support the attainment of this goal.

Meeting the requirements in the revised IHR (2005) is a challenge that requires time, commitment and the willingness to change.

The Regulations in the implementation of the obligations contained in them.

Of the seven areas of work to guide IHR implementation, four of these (2, 3, 4 and 5) are key,

2. Strengthen national disease surveillance, prevention, control and response systems and

3 . Strengthen public health security in travel and transport, address countries' public health capacities to fulfill IHR (2005) requirements.

4 .Strengthen WHO global alert and response systems and

5 . Strengthen the management of specific risks, focus on the necessary surveillance, prevention, control, and response systems at international level.

EPIDEMIC-PRONE DISEASES Cholera, epidemic meningococcal diseases and

yellow fever made an alarming come back in the last quarter of the 20th century and call for renewed efforts in surveillance, prevention, and control.

Emerging viral diseases such as avian influenza in humans, Ebola and Marburg hemorrhagic fevers , Nipah virus, SARS and West Nile fever have triggered major international concern, raised new scientific challenges, caused major human suffering and enormous economic damage.

FOOD-BORNE DISEASES The food chain has undergone considerable and

rapid changes over the last 50 years, becoming highly sophisticated and international.

Although the safety of food has dramatically improved overall, progress is uneven and food-borne outbreaks remain common in many countries.

In addition, some new food-borne diseases have emerged and create considerable concern, such as the recognition of the new variant of Creutzfeldt-Jakob disease associated with Bovine spongiform encephalopathy.

ACCIDENTAL AND DELIBERATE OUTBREAKS

TOXIC CHEMICAL ACCIDENTS West Africa, 2006: the dumping of approximately

500 tons of petrochemical waste in at least 15 sites around the city of Abidjan left eight people dead and nearly 80,000 more complaining of ill health and seeking medical help while other countries were wondering if they could have also been put at risk;

Southern Europe, 1981: 203 people died after consuming poisoned cooking oil that was adulterated with industrial rapeseed oil.

A total of 15 000 people were affected by the tainted oil and no cure was ever found.

RADIO NUCLEAR ACCIDENTS Eastern Europe, 1986: the Chernobyl disaster is

regarded as the worst accident in the history of nuclear power.

The explosion at the plant resulted in the radioactive contamination of the surrounding geographic area and a cloud of radioactive fallout drifted over parts of the western Soviet Union, eastern and western Europe, Scandinavia, the United Kingdom, Ireland and eastern North America. Large areas of the Ukraine, Belarus and the Russian Federation were badly contaminated, resulting in the evacuation and resettlement of over 336 000 people.

ENVIRONMENTAL DISASTERS

Europe, 2003: the heat wave in Europe that claimed the lives of 35 000 persons was linked to unprecedented extremes in weather in other parts of the world during the same period.

Global Outbreak Alert and Response Network (GOARN) provides a framework for the technical coordination of international alert and response activities with institutions and countries around the world.

They lay out new obligations devised to collectively respond to international public health challenges of the 21st century, taking advantage of new developments in biotechnology, surveillance systems, and information technology, such as rapid data sharing.

Unprecedented tools are now available to rapidly detect, assess, and respond to events which represent international public health threats.

IHR (2005) Main legal requirements

Implementing IHR (2005) is an obligation for WHO and States

Parties to theRegulations.

The obligations under the IHR (2005) can be regrouped as

follows:

those related to the core capacity requirements for countries to "detect, assess, notify and report events in accordance with the regulations" and to "respond promptly and effectively to public health risks”

those related to the obligation, permission or prohibition of certain public health actions in respect of international travelers, goods, cargo and conveyances and the ports, airports and border crossings that they utilize.

those related to the administration of IHR such as the nomination in each country of a National IHR Focal point and, for WHO, the nomination of WHO

IHR Contact Points

The six areas for results identified by the WHO Director-General: WHO’s Medium-Term Strategic Plan (MTSP) 2008-2013,

1. Health development,

2. Health security,

3. Capacity,

4. Evidence,

5. Partnership and

6. Performance.